The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    tion of Langenbeck, but reattaches it laterally. He, like Langen- beok, limits the dissection to the removal of’ the mucous membrane. Lawson Tait, in com]) I etc ruptures, has recently also modified the Langenbeck operation. He removes no tissue and operates with scissors. His sutures are inserted in the axis of the wound and surround and bring together large surfaces. The suture should not appear in the rectum, and only the knot should show in the vagina. Two stitches are always sufficient, are of silk, and generally are removed the tenth or twelfth day. Heppner devised a suture for securing equable pressure. It is a figure of 8 in shape and possesses certain advantages. Hadra, of Texas, has recently contributed a series of interesting articles1 upon the lesions and restoration of the pelvic floor. After a careful review of the operative measures commended by various authors, he criticises most of the methods, as in certain respects defective. First, that operations for posterior colporrhaphy are made upon the denuded vaginal muscle and are not resections of the vagina, as in anterior colporrhaphy, now generally recom- mended. His query is pertinent, since if for the anterior portion of the vaginal tract resection is best, why not for the posterior? Again, he places much emphasis upon the vaginal vault or fornix and he has devised some ingenious resections as modified posterior colporrhaphies. Although this review is necessarily brief and imperfect, many excellent suggestions and changes in operative procedures by dis- tinguished men having been omitted, I have endeavored to sketch the outlines of thought which lead up to the present accepted modes of surgical repair. We have seen, with one or two exceptions, that the tissue removed is limited to the mucous membrane, whether the operation is upon the perineum proper, or a posterior colpor- rhaphy. In operations for incomplete ruptures, more or less com- plicated with rectocele and prolapse, the method, with the exception of Wylie’s, consists of an intra-folding of the muscular wall of the vagina in varying pattern. The groupings of the muscles sundered at the perineal raphe and more or less widely separated are, in attempt, included by deep sutures, taken in every manner of direction, while every material used in surgery for sutures finds its advocates. Medical Register. 1S87.
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